20040355.pdfDATE RECEIVED PERMIT EXPIRES JLP
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USE PERMIT -
CITY OF EDMONDS ZONE NUMBER :�ffj-142>f5�.
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CONSTRUCTION PERMIT APPLICATION DURESS �`Pj [4�,
OWNER NAMEINAME OF BUSINESS LL�,
/*I LID NO,
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CITY ZIPTPHONE
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NAME
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CITY
NAME
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STATE LICENSE NUMBE
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EXPIRATION! DATE
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PROPERTY TAX Art,Ol INT PARCELNO.
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NEW El"i"'RESI DENT IAL
JeADDITION E] COMMERCIAL
REMODEL E] APARTMENT
REPAIR GRADING CYDS
DEMOLISH E] TANK
GARAGE ROETAINING WALL
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(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
NUMBER OF
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STORIES
UNITS
DESCRIBE WORK TO BE DONE
LID FEE S
TESCP Ap proved 0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RIN Permit Rqu,11d 0
Street Use Permit Req d 13
EXISTING PROPOSED
Inspection Required Cl
Sidewalk Reqiwecl Cl
REQUIRED DEDICATION— FT
Underground
L11 2, 2_1 0 q 111 - �110
METER SIZE
LINE SIZE
I IXTURES
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PRV REQUIRED
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NUMBER
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'PLAN CHECK NO: IVES TIED DATE
SPECIAL INSPEC
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REMARKS
PROGRESAI
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK -1-0
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
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IL PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
w IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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E EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECT LYOR INDIRECJ LY
m FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL Not BE
01 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENIOF ANY CITY ORDINANCE
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0 NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICAl ION. THAT THE INFORMATION
GIVEN ISCORRECT. ANDTHAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THEOWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONS T RUC
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BF EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RE[ AIING 10
WORKMEN S COMPENSATION INSYRANCE AND RCW 18.27
Al URF,QWNER OCVEN)' DATF SIGNE
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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BUILDING
PLUMBING
MECHANICAL
GRADI�IG/FIL
t-.�J H0CHARGE
ENG REVIEW FEES
ENG. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
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TO ECDC 19.30.0
VALUATION
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OCCUPANT
GROUP
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NSPECTION REO'DI(Ezi
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FEE
TOTAL AMOUN I DIJE RECEIPT �7 Ll I 2_L - I I _L3 IS
APPLICAfION APPROVAL
1 mis appIlcallon is no! it Parmsi until signed by Irift
CALL [31]lldlflg OffiCliril or li�i, her Depuly ana Fes xLl omd,,ini
FOR INSPECTION !oco,pl SlDiicie Provided
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771-0220 EASED 11'r DAI E
EXT 333
771-0221 ORIGINAL- FILE YELLOW INSPECTOR
FAX NK OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS.......................
FQPNDATI ON*:"
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Pier/Porch . .................
—A'eiii6ft-Wall ............ ..
Slab, Insulation ..........
PLUMBINd:
Underground .............
Roygh-In .........
U;-O Z*':
-pory
7 Irperciql Final.
HEffING�- PITH A
Gasje*9t'..--."
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Gas Piping .................
04
Equipment ...... ; .........
Commercial Final
EXTERIOR SHEATHING
NAILING..........................
FRAMING........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
2. 0, 9 t/. - 0,365
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